Primary Ewing Sarcoma of the Left Kidney: A Rare Case Report with Review of Literature

Ewing sarcoma (ES) refers to a collection of undifferentiated growths that originate from neuroectoderm cells. The occurrence of ES in the kidneys is exceedingly uncommon. ES of kidney frequently metastasize to various areas of the body. A 21-year-old female presented with complaints of palpable lump in the left hypochondrium since past 3 months associated with intermittent pain and hematuria. Contrast enhanced computed tomography (CECT) revealed heterogeneously enhancing lesion involving entire left kidney associated with pulmonary nodules and pleural effusion. Fluorodeoxyglucose-positron emission tomography computed tomography (FDG PET) scan confirmed lung and liver metastasis. In view of metastatic disease, a percutaneous biopsy of renal mass was performed preoperatively and ES was diagnosed on immunohistochemistry (IHC) and not confirmed before. Neoadjuvant treatment started as per EFT-2001 protocol, which resulted in resolution of distant metastasis and downstaging of tumor. Then the patient underwent laparoscopic left radical nephrectomy and the final Histopathology report (HPR) showed a significant reduction in tumor size with no signs of metastasis. Given the spread of several metastases and the harsh treatment approach, the likelihood of surviving for ES confined to the kidney is improved, although individuals with cancer that has metastasized from the beginning have a reduced survival probability. The neoadjuvant chemotherapy is very effective in ES. The multidisciplinary approach is beneficial in this tumor.